Percutaneous catheter placement via guide wires has been in use in the medical field in the United States of America since at least 1979.(A) Indications and procedures for use of guide wire catheter now are employed in a variety of surgical specialties and sub-specialties. Urologists, gynecologists, generalists, chronic disease, hospice and even cardiac surgeons are becoming increasingly involved in its use.(B-E) The drainage of intraabdominal or retroperitoneal cavities or organs, in the debilitated or non-debilitated via the percutaneous route, has largely remained within the purview of the radiologist, as these procedures are usually performed with simultaneous or concurrent internal imaging and effective imaging is essential to drainage of these cavities. Additionally, endoscopic guided procedures such as percutaneous gastrostomy (F) and peritoneoscopy (G) are becoming more common in other non-surgical specialties, as well.
Percutaneous procedures via guide wires for access to the pleural cavity, urinary bladder, the stomach, kidney or abscess may not, initially appear similar. They do, however, share two important facts. First, the properties of the fascia, peritoneal cavity and other intra- or retro-peritoneal structures complicate accurate, safe, comfortable percutaneous procedures through tissue layers. Second, once these layers are traversed while avoiding nearby "obstacles", it is crucial that one cavity wall be penetrated, with all care taken to avoid perforating the "back wall".
Being the most frequently performed invasive trans-abdominal gynecologic procedure,(H) laparoscopy has remained a little changed technique since first described in English texts in the late 1960's.(I) Indications continue to become more widespread to include possible utility in the diagnosis of appendicitis (J), as well as the surgical therapy, not merely diagnosis, of acute ectopic tubal pregnancies.(K) In such procedures, it is essential that laparoscopic trocar insertion also needs care to avoid penetrating or damaging the back wall, i.e., intra-abdominal viscera, perforation after traversing the anterior abdominal wall layers.
After the technique of using the guide wire, access catheter sheath was described for other than small to medium sized vessels, (L) and also described in my U.S. Pat. No. 4,813,929, issued Mar. 21, 1989, the utility of applying this approach to various clinical needs became apparent to me. I became sure that the technique could be applied to a variety of intracorporal cavities, provided some type of either indication of the proximity of the "back wall" or a positive protection against its penetration is provided.
Since Lunderquist first described the use of a guide wire in a transhepatic cholangiogram in 1979, (A), above, a variety of guide wire designs have been developed. They include heavy duty version (M), a super stiff one, (N) a stiff fine design, (O), a movable core modified (P), a new torque version (Q), a modified Lunderquist form (R), a double ended configuration (S), a stiff version with a floppy tip (T), a newer floppy tip (U), a variable length J shape (V), a double ended curved form (W) and even extensions (X) have all been described in the literature identified at the end of this specification with corresponding parenthetically enclosed capital letters. They have been of various alloys including platinum (Y), as well as plastic coated (Z). Various diagnostic and therapeutic maneuvers have been described including shaping the guide wire (AA), a double guide wire technique (BB), stiffening Hickman catheters for cut-down insertion (CC), and even 10 passing from the renal pelvis out the urethra for ureteral catheter placement. None have provided for effective sensing or significant protection from penetrating the "back wall".